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Ohio Department of Medicaid | 50 West Town Street, Suite 400, Columbus, Ohio 43215 Consumer Hotline: 800-324-8680 | Provider Integrated Helpdesk: 800-686-1516 Powered by
- Capitation Versus Fee-For-Service
- Patient Satisfaction
- Access to Healthcare
- Ambulatory Care Sensitive Conditions
- Pay-For-Performance
- Diabetes
- Cardiovascular Disease
- Respiratory Diseases
- Multiple Diagnoses
- Preventive Care
Seven studies compared capitation to fee-for-service. Most studies were from the US and addressed outcomes related to health care access and utilization. Overall findings from the studies are summarized in Table 1.
One study assessed the impact of reimbursement system on patient satisfaction. In a nationwide telephone survey in the US, participants were asked to rank their last visit to the primary care physician . Minority groups (Black, Hispanic, and Native American/Asian/Pacific Islander) reported lower satisfaction than whites in a capitated insurance pla...
A US study found that there were less racial differences in access and utilization of care among Medicaid beneficiaries under managed care insurance plans (primarily capitation) than under fee-for-service plans. Differences in the proportion of enrolees who had a usual source of care, had visited any doctor in the last year, or had used ER in the l...
Higher rates of ACSC admissions indicate limited access to and lower quality of primary care . Bindman et al. compared ACSC admissions among Medicaid fee-for-service enrolees to Medicaid managed care enrolees in California between 1995 and 1999 . The study found that ACSC admission rates were lower in managed care patients than fee-for-service pati...
A majority of the studies on pay-for-performance evaluated the impact of QOF on quality of care. According to this scheme, general practitioners in the UK are rewarded for achieving predetermined targets that represents up to 25 % of the practices’ income . The studies included in this review addressed disease-specific and composite outcomes, and t...
Alshamsan et al. compared the change in diabetes-related measurements for three time periods, i.e. pre-QOF, immediately after the introduction of QOF, and post-QOF . The study noted that levels of mean HbA1c, total cholesterol and mean systolic blood pressure were decreasing in all ethnic groups (white, black and South Asian) prior to QOF, and the ...
The proportion of patients that achieved target levels of indicators for cardiovascular disease improved significantly after the implementation of QOF in a serial cross-sectional study . White patients had their blood pressure measured more frequently than south Asians and achieved target levels of blood pressure to a greater extent than blacks pri...
In a serial cross-sectional study from the UK, the introduction of QOF and new clinical guidelines for COPD patients increased the registration of spirometry data and use of combination inhalers for all patients, with no differences between deprivation quintiles .
Bhalla et al. studied the impact of pay-for-performance in a large, integrated health care delivery system in New York City. The providers were evaluated on a number of quality indicators that were grouped into five domains: diabetes, CHD, heart failure, screening and prevention, and all care . Comparisons before and after the introduction of the p...
Based on cross-sectional data from Scotland in 2003–2004 and 2006–2007, influenza immunization uptake in the population aged ≥65 years and in clinical risk groups increased after the introduction of QOF, but pre-existing inequalities by deprivation status persisted . A longitudinal cohort study of 4,284 patients in the UK found a significant increa...
- Wenjing Tao, Wenjing Tao, Janne Agerholm, Janne Agerholm, Bo Burström, Bo Burström
- 2016
Jan 1, 2024 · Ohio Administrative Code. le 5160-2-75 Outpatient hospital reimbursement.Effective: January 1, 2024For purposes of this rule, eligible providers of hospital services as defined in rule 5160-2-01 of the Administrative Code and assigned to prospective payment peer group as described in rule 5160-2-05 of the Administrative Code are subject to the ...
workforce. Together, these pillars help ensure access to health care which leads to improved health outcomes and reduced disparities. inside A snapshot of key access indicators in Ohio 2 Why health insurance matters 5 Barriers to access 7 Oral health care access challenges 11 Mental health care access challenges 11
Rule 5160-2-10 | Payment policies for disproportionate share and indigent care adjustments for psychiatric hospitals. Rule 5160-2-12 | Appeals and reconsideration of departmental determinations regarding hospital inpatient and outpatient services. Rule 5160-2-13 | Utilization review.
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We estimated opportunity costs for all ambulatory medical visits and also for the subset of visits by employed individuals through methods used previously to determine opportunity costs of informal elder care. 18. For employed ATUS respondents (n = 1925, 49% of all respondents with a visit), we estimated opportunity costs using self-reported wages.
